CPT 38305 Incision & Drainage Reimbursement | OpenPayer

Summary & Overview

CPT 38305: Incision and Drainage of Lymph Node Abscess

CPT code 38305 denotes incision and drainage of an abscessed or infected lymph node, typically performed when the affected node is enlarged, inflamed, or located deep enough that simple aspiration is inadequate. Nationally, this code captures a focused surgical intervention that can be performed in an outpatient surgical suite, ambulatory procedure center, or operating room, and it is relevant to surgical, infectious disease, and wound care billing workflows.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, a summary of common billing modifiers and claims considerations, and what to expect from payer coverage patterns and reimbursement conversations. The report highlights typical sites of service and common clinical indications for use, and it outlines benchmarks and policy updates where available. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 38305lymph nodeincision and drainagesurgical procedureoutpatient surgeryinfectious diseaseprocedure codingambulatory surgery

Billing Code Overview

CPT code 38305 describes a surgical procedure in which the provider makes an incision over an enlarged or inflamed lymph node and drains the abscess or infection within the node. This procedure is used when the infected area is large or the abscess is located in deep lymph nodes and simple needle drainage is insufficient.

Service type: Surgical incision and drainage of lymph node abscess
Typical site of service: Operating room or procedure suite for deep lymph node access; may also be performed in an outpatient surgical center when appropriate

Clinical & Coding Specifications

Clinical Context

A 42-year-old patient presents to the emergency department with a 5-day history of a progressively enlarging, painful submandibular mass, fever, and erythema. Examination and point-of-care ultrasound demonstrate a fluctuant enlarged lymph node consistent with an abscess deep to the platysma and adjacent to salivary structures. Oral antibiotics and bedside needle aspiration were attempted without sustained improvement. The surgical team consents the patient for operative incision and drainage of the infected lymph node under monitored anesthesia care. In the operating room, a targeted skin incision is made directly over the enlarged node, careful dissection identifies the inflamed lymph node, and purulent material is drained and sent for culture. Hemostasis is achieved, irrigation performed, and a small drain or packing may be placed if clinically indicated. The patient is observed postoperatively, continues appropriate antibiotics, and receives wound care instructions and follow-up for culture results and possible further debridement if necessary.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal or uncomplicated service	Use when the procedure was routine without complications or unusual circumstances.
`22`

CPT 38308: Incision/Drainage to Improve Lymph Flow or Treat Lymph Node Infection

CPT-38300-LYMPH-NODE-INCISION-AND-DRAINAGE

CPT 38300: Incision and Drainage of Enlarged or Infected Lymph Node

CPT-38380-THORACIC-DUCT-REPAIR-CERVICAL-APPROACH

CPT 38380: Repair of Cervical Thoracic Duct

CPT-38381-THORACIC-DUCT-REPAIR-THORACOTOMY-STERNOTOMY

CPT 38381: Thoracic Duct Repair via Thoracotomy or Sternotomy

CPT-38382-THORACIC-DUCT-REPAIR-ABDOMINAL-APPROACH

CPT 38382: Thoracic Duct Repair via Abdominal Approach

Taxonomy Code	Specialty	Notes
2080S0002X	Otolaryngology (ENT)	Common specialty for head and neck lymph node drainage and deep cervical infections.
207L00000X	General Surgery	Frequently performs incision and drainage for deep or complicated lymph node abscesses.
207P00000X	Plastic Surgery	Involved for complex soft-tissue management or reconstructive needs after drainage.
2084P0800X	Oral and Maxillofacial Surgery	Involved when abscesses are in submandibular or perimandibular locations.
1744S0125X	Emergency Medicine	Performs initial evaluation and may perform bedside drainage or coordinate operative management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L04.0`	Acute lymphadenitis of face, head and neck	Direct indication for incision and drainage when an involved lymph node is abscessed or unresponsive to antibiotics.
`L04.1`	Acute lymphadenitis of axilla and upper limb	Relevant when deep axillary nodes form an abscess requiring operative drainage.
`L04.2`	Acute lymphadenitis of inguinal region	Applicable when inguinal lymph nodes are infected and require incision and drainage.
`L02.211`	Cutaneous abscess of right neck	Overlaps with lymph node abscesses in the neck region; may require surgical drainage.
`L02.212`	Cutaneous abscess of left neck	Same relevance for contralateral neck abscesses needing incision and drainage.
`A41.9`	Sepsis, unspecified organism	Systemic infection complicating localized lymph node abscess, may prompt more urgent surgical drainage.
`B95.6`	Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere	Common causative pathogen for lymph node abscesses; culture-directed therapy follows drainage.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10060`	Incision and drainage of abscess; simple or single	Performed for superficial abscesses when bedside or limited incision suffices instead of `38305`.
`10061`	Incision and drainage of abscess; complicated or multiple	Used for more complex or multiple abscesses often managed alongside deep lymph node drainage.
`10160`	Puncture aspiration of abscess	May be attempted as a less invasive procedure prior to proceeding to formal incision and drainage like `38305`.
`10140`	Incision and drainage of hematoma, seroma or fluid collection	Used when a post-procedural or postoperative fluid collection requires drainage in the same anatomic region.
`20526`	Fascia, muscle and/or tendon injection; with ultrasound guidance, therapeutic	May be used for adjacent soft-tissue procedures under imaging guidance during complicated infections.
`49560`	Drainage of peritoneal abscess; open or percutaneous	Example of other drainage procedures in a broader workflow of abscess management when infection is disseminated.

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